Department of Public Health

Mapping hotspots, trends, and drivers of recent HIV infections among TASO clients in Uganda (2021-2024)

Sat, 01 Nov 2025 00:00:00 GMT

Mapping hotspots, trends, and drivers of recent HIV infections among TASO clients in Uganda (2021-2024) Nsubuga, Sydney Background Despite significant progress on HIV control in Uganda, the population-level viral suppression rate remains low at 74.9% and Uganda now records about 50,000 new HIV infections annually, which underscores the need to detect geographic hotspots and programmatically relevant drivers among clients entering care. . Recent HIV infections, defined as those acquired within twelve months, are important indicators of ongoing transmission and the extent of prevention efforts. However, data at the subnational level regarding recent infections, their geographic clustering, temporal trends, and risk factors are limited. This study aimed to map the spatial distribution, identify temporal trends, and explore the drivers of recent HIV infections among clients of The AIDS Support Organization (TASO) in Uganda from 2021 to 2024. Methods: A retrospective, multiple-methods study design was employed, utilizing routinely collected HIV recency testing data from 11 TASO centers across Uganda. Individuals newly diagnosed with HIV were classified according to the national recent infection testing algorithm (RITA) detailed in Figure 1-3. Spatial analysis involved empirical Bayesian smoothing, Global and Local Moran’s I, and Getis-Ord Gi* techniques to identify hotspots. Temporal trends were evaluated using Mann-Kendall tests and time-series clustering. Multivariable logistic regression identified individual-level predictors of recent HIV infection. Data were extracted from electronic medical records and analyzed with ArcGIS Pro, R, and Stata. Results: A total of 8,276 HIV-positive clients were analyzed for hotspot and temporal trend detection, and 5,422 clients for identifying drivers of recent HIV infection. Spatial analysis revealed persistent and emerging hotspots, including a new outbreak in Kyenjojo (2024) and sporadic clusters along the southwestern and eastern cattle corridors. No district showed sustained or increasing hotspots, while districts in the Lake Victoria basin experienced episodic surges. Temporal patterns were mostly oscillatory. Sixty-four districts maintained near-zero incidence over 48 months, indicating epidemic control through stable treatment and low-risk behavior. Forty-five districts showed a gradual increase from late 2022, peaking in mid-2023 before declining, reflecting mobility-driven surges linked to the post-COVID-19 reopening. Another 37 districts experienced short-lived urban and peri-urban spikes in mid-2022 and early 2023, which were quickly contained through responsive health interventions. In multivariable analysis, male clients had significantly lower odds of recent HIV infection compared to females (OR = 0.74; 95% CI: 0.57–0.96; p = 0.021). Other variables, age, education, HIV testing approach, delivery model, pre-test counseling, and ARV adherence, were not significantly associated with HIV recency (p > 0.05). Conclusion: The study found an overall HIV recency prevalence of 10.5% among TASO clients, with significant variation across centers and over time. Centers in the southwestern and eastern regions, especially along the Cattle Corridor and the Lake Victoria basin, experienced episodic surges. At the same time, most other districts consistently maintained low or zero recency rates. A new hotspot appeared in Kyenjojo in 2024, indicating localized outbreaks amid general epidemic control. Temporal analysis revealed oscillating trends, with brief peaks in mid-2022 and early 2023, corresponding to post-COVID mobility and economic reopening. These findings emphasize the fragmented and changing nature of recent HIV infections across Uganda. Targeted surveillance, rapid response, and geographically focused prevention strategies are critical to maintaining epidemic control and progressing toward the 2030 HIV elimination goals. Dissertation

Factors associated with perinatal mortality in Mbale regional referral hospital:

Sun, 01 Jan 2023 00:00:00 GMT

Factors associated with perinatal mortality in Mbale regional referral hospital: Wepondi, Isaac Globally, 2.6 million babies die annually during perinatal period. Majority, (95%) occur in low- and middle-income countries (LMIC) posing a significant public health problem. The East African regional perinatal mortality was 34.5%, Uganda was 38% while Mbale was 41%. Understanding factors associated with perinatal mortality in Mbale was studied and will guide policy formulation and improved local clinical practice. Objectives: To describe factors associated with perinatal mortality in Mbale regional referral hospital. Methods: A cross-sectional study was conducted in Mbale regional referral hospital from August 2022 – December 2022. Three hundred sixty-eight (368) participants were consecutively enrolled into the study. The primary outcome was perinatal mortality, which included stillbirths and early neonatal deaths. Other factors like pre-term births, birth asphyxia and birth trauma were also believed to be contributing to perinatal mortality. We used Stata 15 (Stata Corp, 2015) and carried out logistic regression to measure the association between the independent variables (maternal, health system and newborn characteristics) and dependent variable (perinatal mortality) at 95% confidence interval and p-value of 0.05 Results: About 1 in 10 [42/370(11%)] mothers delivered babies who died during the perinatal period, translating to a perinatal mortality rate of 113 babies per 1000 births. The risk factors included newborn infections [AOR 4.8,95% CI - (1.2, 17.5)] and babies born with Apgar score less than 7 [AOR 0.02, 95% CI - (0.005, 0.1)]. Thess factors were significantly associated with perinatal mortality at multivariable analysis. However, occupation [AOR 0.2,95% CI - (0.1, 0.8)], was protective. Conclusion and recommendations: Newborn infections and Apgar score < 7 were the significant factors associated with perinatal mortality in Mbale regional referral hospital. Attending the recommended ANC visits, delivering in established health facilities, being employed and producing babies with Apgar score >7, reduced perinatal mortality. Dissertation

Feasibility, acceptability and experiences of intrapartum fetal monitoring by caregivers using the Moyo device at Mbale regional referral hospital:

Sat, 01 Nov 2025 00:00:00 GMT

Feasibility, acceptability and experiences of intrapartum fetal monitoring by caregivers using the Moyo device at Mbale regional referral hospital: Nakawuki, Ashley Winfred Background: Intrapartum fetal heart rate monitoring (FHRM) is essential for identifying fetal distress and preventing asphyxia-related complications. However, inadequate FHRM due to staffing shortages is a critical issue in low-resource settings such as Uganda, where intrapartumrelated neonatal deaths are high. The Moyo device, a portable fetal heart rate (FHR) monitor, reduced perinatal morbidity and mortality in a recently conducted trial in Mbale. However, its potential remains underutilized due to a high patient-to-midwife ratio. Recent evidence suggests that task-sharing FHRM with caregivers may address poor fetal monitoring practices, enabling non-clinical individuals to support the timely identification of fetal distress. Objective: This study assessed the feasibility, acceptability, and caregivers' experiences with intrapartum FHRM using the Moyo device at Mbale Regional Referral Hospital (MRRH), Eastern Uganda. Methods: A pilot quasi-experimental study design was used employing a sequential explanatory mixed-methods approach at MRRH. Caregivers of labouring women were consecutively enrolled, trained, and guided to monitor FHR every 30 minutes using the Moyo device. Feasibility was defined as achieving a mean monitoring interval within 30 ± 5 minutes, while acceptability was assessed using a five-point Likert scale converted into percentage scores and categorized using Bloom’s criteria. Experiences of caregivers who used the Moyo were explored through structured, in-depth interviews. Quantitative data were analysed using Stata version 17, and qualitative data were analysed thematically using Atlas. ti. Results: A total of 75 caregivers participated, with a median age of 32 years (IQR: 25–42). Most were female (n=70, 93.3%) and had primary-level education (n=35, 46.7%). The majority of participants (n=74, 98.7%) were able to use the Moyo device to check and document FHR, with 65 (86.7%) reporting no technical issues. However, only 34.7% (n=26) of caregivers were able to monitor FHR at 30-minute intervals, and 65.3% (n=49) of readings within 60 minutes. The median number of FHR recordings was 3 (IQR: 1–10), and the mean duration of the active stage of labour was 10.9 ± 9.7 hours. Feasibility was higher among caretakers who were first or second-degree relatives (61.5%; p = 0.037). The majority of the caregivers (n=70, 93.3%) found FHRM using the Moyo device acceptable. Caregivers reported positive experiences with the Moyo device, driven by curiosity, reassurance about fetal safety, and a desire to learn. Conclusion: Intrapartum FHRM by caregivers using the Moyo device was highly acceptable, and most caregivers correctly used the device. However, adherence to the recommended 30-minute monitoring interval remained low. Similar initiatives involving caregivers should prioritize practical support systems like reminders and workflow integration to enable timely recordings and improve adherence to recommended FHR monitoring. Dissertation

Incidence, time to and predictors of HIV-seroconversion among HIV Exposed infants after the first PCR: a retrospective analysis of the national EID data of 2019-2024

Sat, 01 Nov 2025 00:00:00 GMT

Incidence, time to and predictors of HIV-seroconversion among HIV Exposed infants after the first PCR: a retrospective analysis of the national EID data of 2019-2024 Makoko, Brian Tonny Background: HIV seroconversion among HIV-exposed infants (HEIs) remains a major public health concern, particularly in settings with high maternal HIV prevalence. Despite remarkable progress in the prevention of mother-to-child transmission (PMTCT), some infants who initially test negative after birth later acquire HIV during breastfeeding. Understanding the incidence, timing, and predictors of HIV seroconversion is vital to guide interventions that strengthen Uganda’s Early Infant Diagnosis (EID) program and improve infant health outcomes. Methods: A retrospective cohort study was employed to follow-up HEI who initially tested HIV-negative on their first PCR enrolled in the national EID program. Data was obtained from the Central Public Health Laboratory (CPHL) database from 2019 to 2024. Data was cleaned and analysed using Stata version 18. The incidence rate of HIV seroconversion was computed as the number of new HIV infections per 1,000 person-months of follow-up. Time to seroconversion was estimated using Kaplan–Meier survival analysis, with the log-rank test used to compare survival distributions across subgroups. Cox proportional hazards regression was employed to identify independent predictors of HIV seroconversion Results: In this study, 59,471 HIV-exposed infants who initially tested HIV-negative at the first PCR were followed for 24 months retrospectively with 1,368 (2.3%) seroconverting during the follow-up period, yielding an overall incidence rate of 1.18 per 1,000 person-months (95% CI: 1.12–1.24). The mean time to HIV seroconversion was 10.8 months (95% CI: 10.1– 11.6), with most infections occurring within the first year of life. Multivariable Cox regression identified three significant predictors of HIV seroconversion: infant age 13–24 months [aHR: 3.1; 95% CI: 2.012–4.858; p < 0.001], poor maternal ART adherence (<85%) [aHR: 3.2; 95% CI: 2.122–4.872; p < 0.001], and unsuppressed maternal viral load [aHR: 2.4; 95% CI: 1.644– 3.539; p < 0.001]. Conclusion: The study found that while the incidence of HIV seroconversion among infants after a negative first PCR test remains low, new infections still occur primarily within the first year of life, largely attributable to inadequate maternal ART adherence and lack of viral load suppression. The findings highlight the need to reinforce maternal adherence counselling, routine viral load monitoring, and early weaning strategies aligned with PMTCT guidelines. Strengthening follow-up within the EID continuum and integrating maternal–infant pair management approaches could further reduce postnatal HIV transmission and accelerate progress toward the elimination of mother-to-child HIV transmission in Uganda. Dissertation